Medicina ClinicaPub Date : 2025-05-23DOI: 10.1016/j.medcli.2025.106977
Marc Izquierdo Ribas , Teresa López-Sobrino , Eva Moreno , Oriol de Diego , Carlos Roca , Pedro Cepas , Francisco Rafael Jiménez-Trinidad , Nuria Romeu , Marta Parellada , Silvia Pérez , Xavier Freixa , José Tomás Ortiz-Pérez , Ana García-Álvarez , Rut Andrea
{"title":"Predictive value of bicarbonate levels at admission for severe hypoxic-ischemic encephalopathy after out-of-hospital cardiac arrest","authors":"Marc Izquierdo Ribas , Teresa López-Sobrino , Eva Moreno , Oriol de Diego , Carlos Roca , Pedro Cepas , Francisco Rafael Jiménez-Trinidad , Nuria Romeu , Marta Parellada , Silvia Pérez , Xavier Freixa , José Tomás Ortiz-Pérez , Ana García-Álvarez , Rut Andrea","doi":"10.1016/j.medcli.2025.106977","DOIUrl":"10.1016/j.medcli.2025.106977","url":null,"abstract":"<div><h3>Introduction</h3><div>Mortality after an out-of-hospital cardiac arrest (OHCA) remains excessively high. The use of extracorporeal cardiopulmonary resuscitation at admission may improve survival, but selecting candidates for this therapy is challenging. Finding the best predictive biomarkers of severe hypoxic-ischemic brain injury (HIBI) on arrival might aid in the multimodal decision making. Our aim was to analyse the predictive value of the acid–base balance components in this scenario.</div></div><div><h3>Methods</h3><div>This was a prospective observational study of OHCA patients that achieved return of spontaneous circulation without administration of HCO<sub>3</sub> during resuscitation, admitted to an ICCU of a tertiary care centre. Point-of-care arterial biomarkers on arrival, including pH, pCO<sub>2</sub> and HCO<sub>3</sub> were analysed. The primary objective was severe HIBI.</div></div><div><h3>Results</h3><div>From 2019 to 2021, 50 OHCA patients were included, of which 17 (34%) suffered severe HIBI. Initial pH (6.99<!--> <!-->±<!--> <!-->0.20 vs. 7.14<!--> <!-->±<!--> <!-->0.15, <em>P</em> <!-->=<!--> <!-->0.007) and HCO<sub>3</sub> values (14.13<!--> <!-->±<!--> <!-->3.24<!--> <!-->mEq/L vs. 17.97<!--> <!-->±<!--> <!-->4.28<!--> <!-->mEq/L, <em>P</em> <!-->=<!--> <!-->0.003) were significantly lower in severe HIBI patients, while no difference was observed regarding pCO<sub>2</sub> (52.44<!--> <!-->±<!--> <!-->14.41<!--> <!-->mmHg vs. 51.38<!--> <!-->±<!--> <!-->13.38<!--> <!-->mmHg, <em>P</em> <!-->=<!--> <!-->0.801). HCO<sub>3</sub> showed higher accuracy to predict severe HIBI than pH (AUC of 0.764 vs. 0.727), with a value of 16.5<!--> <!-->mmol/L as the best cut-off point.</div></div><div><h3>Conclusions</h3><div>First HCO<sub>3</sub> levels on admission of OHCA patients who achieved ROSC significantly predicted severe HIBI, unlike pCO<sub>2</sub>, and showed even better accuracy than pH.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"165 2","pages":"Article 106977"},"PeriodicalIF":2.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Medicina ClinicaPub Date : 2025-05-23DOI: 10.1016/j.medcli.2025.106988
Ana I. Curcoy Barcenilla , Nerea Garcia Holguera , Carla Cano Garcia , Marta Simó Nebot , Carles Luaces Cubells , Victoria Trenchs Sainz de la Maza
{"title":"Situación pospandemia COVID-19 del número de casos y perfil de los pacientes atendidos por sospecha de violencia sexual infantil y adolescente","authors":"Ana I. Curcoy Barcenilla , Nerea Garcia Holguera , Carla Cano Garcia , Marta Simó Nebot , Carles Luaces Cubells , Victoria Trenchs Sainz de la Maza","doi":"10.1016/j.medcli.2025.106988","DOIUrl":"10.1016/j.medcli.2025.106988","url":null,"abstract":"<div><h3>Background and objective</h3><div>After the pandemic, the Barcelona adult's reference centre for victims of sexual assault reported a 40% increase in its consultations. Our objective is to determine if cases of suspected child and adolescent sexual violence (CASV) also increased and if the profile of the victims changed.</div></div><div><h3>Materials and methods</h3><div>Cross-sectional study. Patients <<!--> <!-->18 years of age treated for suspected CASV in 2019 and 2022 by a Functional Team of Experts were included and their characteristics were compared.</div></div><div><h3>Results</h3><div>One hundred thirty-fivecases from 2019 and 163 from 2022 were included. 83.2% were female. The mean age was 10 vs. 12 years (<em>P</em>=.064), 11.9% vs. 25.2% (<em>P</em>=.004) had a psychiatric history, and 59.3% vs. 43.6% (<em>P</em>=.039) were referred from the hospital. 0.7% sexually transmitted infections were diagnosed in 2019 vs. 4.3% in 2022 (<em>P</em>=.076). A possible aggressor was reported in 287 (96.9% male): it was a cohabitant in 47.3% vs. 28.8% (<em>P</em>=.001).</div></div><div><h3>Conclusions</h3><div>A substantial increase in cases with suspected CASV was detected; affecting more adolescent girls, more exposed to non-cohabiting aggressors, making it necessary to insist on awareness and prevention campaigns in this age group.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"165 3","pages":"Article 106988"},"PeriodicalIF":2.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144115881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Medicina ClinicaPub Date : 2025-05-23DOI: 10.1016/j.medcli.2025.106976
Javier del Cid Lemus , Carlos Feijoo-Massó , Daniel Valcarcel-Paz
{"title":"Ventricular extrasystoles secondary to mitral valve prolapse as an initial manifestation of cardiac sarcoidosis. A case report","authors":"Javier del Cid Lemus , Carlos Feijoo-Massó , Daniel Valcarcel-Paz","doi":"10.1016/j.medcli.2025.106976","DOIUrl":"10.1016/j.medcli.2025.106976","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"165 1","pages":"Article 106976"},"PeriodicalIF":2.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144116873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Medicina ClinicaPub Date : 2025-05-23DOI: 10.1016/j.medcli.2025.106972
Cristina Tomás , Ángeles Muñoz , Carlos Báguena , Antonia Alcaraz , Rodrigo Martínez-Rodríguez , María Dolores Hernández , María Isabel Martínez , Rubén Corral-San-Miguel , Eduardo Pons-Fuster López , Eva García-Villalba , Salvador Valero , Eva Oliver Galera , Elena Guijarro Westermeyer , Román González Hipólito , Concepción Corbalán Dólera , María del Carmen García Ros , Enrique Bernal
{"title":"Effect of cholecalciferol on 25-hydroxyvitamin D in people living with HIV and vitamin D deficiency: A prospective observational study","authors":"Cristina Tomás , Ángeles Muñoz , Carlos Báguena , Antonia Alcaraz , Rodrigo Martínez-Rodríguez , María Dolores Hernández , María Isabel Martínez , Rubén Corral-San-Miguel , Eduardo Pons-Fuster López , Eva García-Villalba , Salvador Valero , Eva Oliver Galera , Elena Guijarro Westermeyer , Román González Hipólito , Concepción Corbalán Dólera , María del Carmen García Ros , Enrique Bernal","doi":"10.1016/j.medcli.2025.106972","DOIUrl":"10.1016/j.medcli.2025.106972","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess the effect of oral cholecalciferol 50,000<!--> <!-->IU monthly administered in people living with HIV (PLHIV) and 25(OH)D deficiency followed over 48 weeks.</div></div><div><h3>Methods</h3><div>A prospective observational study was conducted in a cohort of 110 PLHIV with 25(OH)D levels<!--> <!--><<!--> <!-->20<!--> <!-->ng/mL. Changes in 25(OH)D levels were evaluated at 3, 6, and 12 months of treatment. The percentages of patients who achieved 25(OH)D levels<!--> <!-->><!--> <!-->20 and >30<!--> <!-->ng/mL and changes in bone mineral density (BMD) were assessed.</div></div><div><h3>Results</h3><div>One hundred ten PLHIV (79% men, mean age 49.46 years) were included. The mean (standard deviation, SD) time on antiretroviral treatment was 10.69 (8.31) years and all patients had a viral load<!--> <!--><<!--> <!-->50<!--> <!-->copies/mL. The mean 25(OH)D levels of 15.10<!--> <!-->±<!--> <!-->3.22<!--> <!-->ng/mL at baseline increased significantly (<em>P</em> <!--><<!--> <!-->0.001) to 27.89<!--> <!-->±<!--> <!-->7.79<!--> <!-->ng/mL at 3 months, 28.53<!--> <!-->±<!--> <!-->8.45<!--> <!-->ng/mL at 6 months and 27.89<!--> <!-->±<!--> <!-->7.92<!--> <!-->ng/mL at 12 months. A total of 87.27% had normal 25(OH)D levels at 12 months (>30<!--> <!-->ng/mL in 36.1% of patients and >20<!--> <!-->ng/mL in 51.5%). Parathormone levels (PTH) also decreased significantly. Treatment was safe and well tolerated. On the other hand, no significant changes were observed in BMD.</div></div><div><h3>Conclusions</h3><div>Monthly administration of 50,000<!--> <!-->IU of cholecalciferol was effective in normalizing 25(OH)D deficiency in 87% of PLHIV, without observing changes in bone mineral density.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"165 2","pages":"Article 106972"},"PeriodicalIF":2.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144115866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Medicina ClinicaPub Date : 2025-05-23DOI: 10.1016/j.medcli.2025.106912
Cristóbal M. Rodríguez-Leal , Juan González del Castillo , Martín Sebastián Ruiz Grinspan , Rosario Susi García , Teresa Pérez Pérez , en nombre del grupo de estudio COVID CODE SPAIN
{"title":"Efectividad y seguridad de remdesivir y nirmatrelvir-ritonavir en la COVID-19 leve-moderada en los servicios de urgencia hospitalaria españoles","authors":"Cristóbal M. Rodríguez-Leal , Juan González del Castillo , Martín Sebastián Ruiz Grinspan , Rosario Susi García , Teresa Pérez Pérez , en nombre del grupo de estudio COVID CODE SPAIN","doi":"10.1016/j.medcli.2025.106912","DOIUrl":"10.1016/j.medcli.2025.106912","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Remdesivir and nirmatrelvir-ritonavir (NTV/r) are the antiviral drugs available in Spain to prevent progression of mild-moderate COVID-19 in vulnerable populations. The pivotal clinical trials of both were conducted under different epidemiological conditions than the current ones. Therefore, their effect in the current setting is uncertain.</div></div><div><h3>Patients and methods</h3><div>A retrospective, multicentre, observational cohort study was conducted in 16 Spanish hospital emergency departments (ED). Data were collected from all patients with mild to moderate COVID-19 who presented to an ED in the first seven days after symptom onset between 1<sup>st</sup> January and 31<sup>st</sup> August 2022. The incidence of hospitalisation or death from any cause at 30 days (composite endpoint) after discharge from the ED was assessed, as was the occurrence of serious adverse drug reactions (ADRs). Data were analysed using Cox multiple regression and standardised survival curves.</div></div><div><h3>Results</h3><div>A total of 2533 patients were included. The use of NTV/r was associated with a reduced risk of the combined endpoint compared to standard of care (SOC): adjusted hazard ratio (aHR) 0.528, 97.5% confidence interval (97.5%CI): 0.330-0.845; number of patients to treat to avoid an event, 24 (97,5%CI 13-283). No difference was detected between remdesivir and SOC: aHR 0.835: 97,5%CI: 0.524-1.394. No serious ADRs were identified.</div></div><div><h3>Conclusion</h3><div>Early use of NTV/r was associated with less risk of progression of mild to moderate COVID-19 in vulnerable patients, while no differences were found between remdesivir and SOC. Their use was safe.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"165 2","pages":"Article 106912"},"PeriodicalIF":2.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144123931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}